1. Health and wellbeingseen from the ground Elizabeth Bayliss Social Action for Health March 2013
2. On the ground in east London• People are fearful of the changes to benefits• People are fearful that the NHS is going to be lost• People are fearful that they will never work again• People are fearful of a government that does not care
3. NHS seen from the ground• GPs are now in charge; they are so busy they do not listen; they never do an examination;• GPs only ever give me paracetomol;• My GP will not refer me to a specialist so I wait til I go home (abroad) and pay for examination there;• Why not go to A&E when I need medical help quickly?• Out of hours doctors do not have my records so what is the point?• Where are the interpreters now? How can I describe my condition when the doctor does not understand me/• Why are there no ESOL classes anymore?
4. It takes two to tango!• NHS behaves as though it can sort out health inequalities and rising demand on its own or somehow through the mystical intervention of the market• The relationship between the NHS and local communities is squeezed through the narrow conduit of ‘community engagement’ which is a reductionist process that leads to an impoverished relationship
5. The relationship matters• There are no shortcuts• Relationships between human beings are always transactional - what is the nature of the transaction;• There has to be a balance of expectations• Professionalism can get in the way, leading to a manufacturing of dependency
6. SAfH values• We start with the people• People have the right to take control of their own lives• People’s health can be improved by tackling isolation, poverty, racism and unemployment• Healthy communities are good for the whole society
7. SAfH Spiral of Participation• SAfH spiral of participation
8. SAfH’s roleSAfH sits in the community, encouraging local people to take more responsibility, to reduce their dependency, increasing their ability to be self determining;We find that people to want to take responsibility - to be of use in their community – no place for paternalism;We work within social mores , respecting leaders;We listen to what people say, preferably in mother tongue, drawing out meaning from their experiences;We give local people accurate information about complex issues like morbidity and mortality rates so that people can see themselves in relation to the wider world;We teach people how to engage with professionals so that the communication both ways is richer and more useful;We tell people with power and authority what we have heard in words the powerful understand.
9. What this means on the groundFocus on the people: √ reach out (on the streets, in community centres, in public places); √ start conversations (We use the promotion of cancer screening to start conversations about self care). √ bring people together – cross culturally √ teach people new skills – go step by step √ encourage these to be shared - Build up mutuality √ promote health intelligence – ability to make sensible decisions about own health and wellbeing
10. Who does the work?• Local people, who are lay, trained, paid, supervised and supported, with multiple languages• We have 100 people at any one time whom we have trained as Health Guides, Mental Health Guides, Self Management and Good Move tutors, Ambassadors, Community Health Champions, Mentors, Representatives.• We have a staff team of around 25 people who support, record, report, manage, coordinate, teach these local people; manage networks of community groups providing information and advice; evaluate work and aim to influence policy and practice.
11. Is the work useful?• Screening take – up increased• Demand on GPs from people who have been through a self management course reduced• Benefit entitlements secured and appeals won• People empowered personally, with evidenced improvement in health and wellbeing;• People more confident in communicating with their GP;• Voices heard by decision makers through platforms eg. Open events;• Health Action groups formed• Community groups forming networks.
12. Scale and impactSAfH works with 11,000 people a year directly but this feels like small fry;Work needs to be rolled out big time;Funding needed to evaluate work eg. Impact on A&E; eg. impact on communities
13. Tips on policy direction!• Funding for evaluation on community development approach• Hospitals and primary care to be encouraged to collaborate on such evaluations• Funding for community work at a local level necessary• Meta narrative – honour the public arena